下咽癌颈部淋巴结转移规律的临床分析

Clinical analysis of cervical lymph node metastasis of hypopharyngeal carcinoma

目的:研究下咽癌颈部淋巴结转移的临床规律,辅助下咽癌治疗。方法:回顾性分析45例下咽癌55侧颈淋巴结清扫术,分析颈部出现淋巴结转移及结外侵犯与临床病理因素的关系。结果:①45例下咽癌颈部淋巴结转移率为75.56%,10例双侧清扫中5例(11.11%)为双侧转移,2例(4.44%)为单侧转移;转移淋巴结结外侵犯率为79.41%,2例(5.88%)为双侧清扫双侧结外侵犯,2例(5.88%)为双侧清扫单侧结外侵犯。②45例共清扫淋巴结411枚,转移淋巴结163枚,转移率为39.66%,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ区转移淋巴结构成比分别为0.61%、49.08%、25.77%、21.47%、3.07%,各区转移率分别为3.57%、62.02%、37.17%、42.17%、8.62%;③Ⅰ+Ⅴ、Ⅱ+Ⅲ+Ⅳ比较差异有统计学意义;Ⅰ、Ⅴ比较差异无统计学意义;Ⅱ、Ⅲ、Ⅳ比较差异有统计学意义;Ⅱ、Ⅲ+Ⅳ比较差异有统计学意义;Ⅱ、Ⅲ比较差异有统计学意义;Ⅱ、Ⅳ比较差异有统计学意义;Ⅲ、Ⅳ比较差异无统计学意义;Ⅰ、Ⅴ分别与Ⅱ、Ⅲ、Ⅳ、Ⅱ+Ⅲ+Ⅳ比较均差异有统计学意义。④T1+T2与T3+T4两组之间和T1、T2、T3、T4任意两期之间淋巴结转移率和结外侵犯率比较差异无统计学意义。⑤原发灶主要位于梨状窝者和梨状窝外者的颈部淋巴结转移率和结外侵犯率比较均差异无统计学意义。⑥原发灶侵犯颈段食管与否的颈部淋巴结转移率和结外侵犯率比较均差异无统计学意义。⑦N1、N2、N3任意两期之间转移淋巴结结外侵犯率比较差异无统计学意义。⑧临床Ⅰ+Ⅱ+Ⅲ期组与Ⅳ期组及Ⅱ与Ⅳ期淋巴结转移率比较均差异有统计学意义;临床Ⅲ、Ⅳ期转移淋巴结结外侵犯率比较差异无统计学意义。结论:下咽癌颈淋巴结转移主要分布在Ⅱ、Ⅲ、Ⅳ区,以Ⅱ区最多。T分期、原发灶部位与颈淋巴结转移率和结外侵犯率无关,原发灶侵犯食管颈段并不增加颈部淋巴结转移率和结外侵犯率。N分期增高不增加转移淋巴结结外侵犯率。Ⅳ期颈淋巴结转移率明显增加。

Objective：To investigate the pattern of cervical lymph node metastasis in hypopharyngeal carcinoma.Method：Forty-five cases of hypopharyngeal squmous cell carcinoma were analyzed retrospectively.Result：①The total rate of lymph node metastasis was 75.56%.11.11% metastased for bilateral neck and 4.44% did unilateral neck in 10 bilateral neck dissection.The total distance metastasis rate out of lymph node were 79.41%.The rate of bilateral distance metastasis and unilateral distance metastasis were both 5.88% in 10 bilateral neck dissection.②163 of 411 lymph nodes（39.66%） were positive.The percentage of positive lymph node were 0.61%,49.08%,25.77%,21.47% and 3.07% in regionⅠ,Ⅱ,Ⅲ,Ⅳ and Ⅴ respectively.The rates of lymph node metastasis were 3.57%,62.02%,37.17%,42.17% and 8.62% in regionⅠ,Ⅱ,Ⅲ,Ⅳ and Ⅴ respectively.③The statistical significant differences were found between regionⅠ＋Ⅴ and Ⅱ＋Ⅲ＋Ⅳ（P0.05）,among Ⅱ,Ⅲ and Ⅳ（P0.05）,betweenⅡ and Ⅲ＋Ⅳ（P0.05）,betweenⅡ and Ⅲ（P0.05）,between Ⅱ and Ⅳ（P0.05）,amongⅠ,Ⅱ,Ⅲ,Ⅳ and Ⅱ＋Ⅲ＋Ⅳ（P0.05）,among Ⅴ,Ⅱ,Ⅲ,Ⅳ and Ⅱ＋Ⅲ＋Ⅳ（P0.05）.There were not statistical significant differences in region between Ⅲ and Ⅳ（P0.05）,between Ⅰ and Ⅴ（P0.05）.④There were not statistical significant differences in the rates of lymph node metastasis and capsule invasion between T1＋T2 and T3＋T4（P0.05）,among T1,T2,T3 and T4（P0.05）.⑤There were not statistical significant differences in the rates of lymph node metastasis and distance metastasis between pyriform sinus and out of it（P0.05）.⑥There were not statistical significant differences in the rates of lymph node metastasis and distance metastasis between cervical esophagus invasion and not（P0.05）.⑦There were not statistical significant differences in the rates of lymph node metastasis and distance metastasis among N1,N2,N3（P0.05）.⑧There were statistical significant differences in the rates of lymph node metastasis between clinical stageⅠ＋Ⅱ＋Ⅲ and Ⅳ,betweenⅡ and Ⅳ（P0.05）.While there were not statistical significant differences in the rates of distance metastasis between Ⅲ and Ⅳ（P0.05）.Conclusion：The lymph node metastasis was mainly in the region Ⅱ,Ⅲ and Ⅳ,especially in the region Ⅱ.T stage,primary site and cervical esophagus invasion were not related to neck lymph node metastasis and distance metastasis.N stage was not related to distance metastasis.Clinical stage Ⅳ had a higher lymph node metastasis rate.